Job Description

Job Title: Medical Billing Specialist
Job ID: 646187
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Mon Yough
Department: MH Targeted Case Mgmt
Location: 500 Walnut Street, Mckeesport PA 15132

Description

Job Summary:

Are you an experienced billing professional looking to advance your career with UPMC? Mon Yough Community Services is hiring a Medical Billing Specialist to support the Targeted Case Management department during daylight hours on Monday through Friday. The primary function of the Medical Billing Specialist is to provide billing, account receivable, and collections services and to monitor unbilled services for assigned funding sources.

Responsibilities:
  • Accurate and timely data entry into payer websites for original claim submissions and/or corrected claims submissions.
  • Communicate appropriately utilizing a service account.
  • Convey an outstanding first contact experience to all customers, including internal and external contacts
  • Efficiently and accurately documents detailed notes in Psych Consult Patient Accounts Screen and review notes documented by others before proceeding on issues.
  • Follow up on corrected claims to ensure filing time guidelines are met.
  • Forward all authorization issues/concerns to the Managed Care/Billing Specialist timely to ensure revenue is not lost. Document in system.
  • Generate primary and secondary paper bills according to established procedures and edit paper claims before mailing.
  • Good oral and written communications skills required.
  • Identify and communicate to up-line any PsychConsult issues such as fee matrix, CPT codes, units or rates to eliminate inefficiencies and/or obstacles in billing process
  • Identify and communicate to up-line delays affecting balancing issues, new codes, or adjustments.
  • Monitor payer websites for benefit information and requirements. Timely communication to manager if our system needs updated for accurate billing.
  • Perform claim follow up on denials quickly and accurately from assigned payers to ensure revenues are received timely.
  • Proficient with personal computer base applications and other various office equipment
  • Re-bill accounts as necessary to ensure an open insurance receivable against which a payment can be applied.
  • Receive incoming telephone and email inquiries from patients, families, internal staff and insurance companies and resolve/refer appropriately.
  • Reconcile funds in the bank to payments posted.
  • Run 837 files according to established procedures. Resolve any validation issues
  • Scan, OCR and redact in scanning software.
  • Suggest new work flows and/or office procedures to increase customer satisfaction and/or staff productivity.
  • Support co-workers towards completion of assigned projects/tasks.
  • Thoroughly research questionable/unidentified payment in order to post properly or refund to payer per payer guidelines.
  • Verify NAP (non-applied cash) issues and work to resolve.
  • Verify and post remittance from assigned payers.
  • Work open/billed reports and/or aged reports timely to ensure revenue is not lost.
  • Work with payers and subscribers to resolve issues and facilitate prompt payment of claims.

Qualifications

  • High School Diploma or GED required. 
  • Associate Degree in Accounting Field preferred.
  • Minimum of four years of experience in an accounts receivable environment with three years specific to healthcare billing, including cash posting, submitting paper and electronic claims, working rejections/denials required. 
  • Five years of experience in healthcare field working specifically in billing, coding or insurance verification/authorizations and contracts/credentialing. 
  • Knowledge of insurance reimbursement guidelines for Medical Assistance, Commercial Plans, Medicare and Medicare HMO Plans required. 
  • Knowledge of Allegheny County guidelines preferred

Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $11.81 to $17.98

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

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